Pharmaceuticals from Households: A Return Mechanism (PH:ARM)

Transcription

1 Pharmaceuticals from Households: A Return Mechanism (PH:ARM) A Washington State Pilot Program Emma Johnson Washington State Department of Ecology Solid Waste and Financial Assistance Program April 24, 2007

2 PH:ARM Team State Agencies: Washington State Department of Ecology Washington State Board of Pharmacy DSHS, Aging and Disability Services Local Agencies: Interagency Resource for Achieving Cooperation (IRAC) Local Hazardous Waste Management Program in King County Snohomish County Solid Waste Management Division Public Health Seattle & King County Non-profits: Northwest Product Stewardship Council Washington Citizens for Resource Conservation Pacific NW Pollution Prevention Resource Center (PPRC) Private Partners: Bartell Drugs Group Health Cooperative

3 Our Goals Answer unmet need for proper household disposal Keep drugs out of the environment Improve community safety Make producers responsible for product Fix regulatory barriers

4 Why this Project is Important Overdosing, medication mistakes, child poisoning, abuse of drugs Environmental risk caused to the Puget Sound, endangered salmon, aquatic organisms, and other unknown impacts Mechanism for legal disposal non-existent

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6 Waste Generation Rate: Households HOUSEHOLDS PhRMA estimates of 3% of all meds go unused 3 Billion prescriptions filled in US in British survey: 82% do not finish antibiotics 50% do not finish antidepressants 50% do not finish beta-blockers 20% do not finish pain meds $1 billion worth of unused drugs are flushed down the toilet each year (2003) Only 1% of Households in King County had no medicine containers (2006) 10% are using or will use none 33% will use all medications

7 Ongoing, provincial, industry-financed program: British Columbia Ongoing, permanent program since 1996 Administrated by the Residuals Management Group Ltd., with funding by the Post Consumer Pharmaceutical Stewardship Association (industry association) Collected 44,092 lbs in 2006 Total cost is $248,000/year Serves 4 million people

8 Ongoing, national, government-financed* program: Australia Ongoing, permanent program since 1998 *Wholesaler discounts delivery and collection, government pays for disposal and advertising Collected 696,241 lbs in 2005 US $737,000 a year in costs Serves 21 million people

9 Results of a BC-type Program British Columbia Washington Full Program (Potential Results from a BC Model) Total lbs of medicines 44,092 lbs (2006) 36 million pills 66,000 lbs (population estimate) 54 million pills Packaging Not collected 28 % by weight is packaging Cost $248,000 annually $5.60 per lbs $473,000 annually (assume $5.60 per lbs) # of Sites 802 pharmacies 1,301 pharmacies

10 Current Disposal Practices 52% dispose of unwanted medicines in the garbage while 20% flush them. (SoundStats Survey of King County, 2006) Only 1.4% of the American public returned unused medication to the pharmacy, whereas 54% threw them away and 35.4% disposed of them in the sink/toilet. (Kuspis and Krenzelok 1996)

11 A Simple Program Gets Results It should be as easy to safely dispose of unwanted medications as it is to purchase them. 74% are willing to properly dispose of their unwanted medicines if a convenient location is offered. 80% said they d likely return their unwanted medicines to a secure drop box at their pharmacy. -SoundStats Survey of King County, 2006

12 Segregation of Controlled Drugs Not Practical or Effective Clark County model (400,000 people or 7% of state population) 4 police offices 19 lbs of controlled drugs Washington State approach (6 million people) 1,301 pharmacies 6,600 lbs - 43,000 lbs of controlled drugs 4% of survey respondents consider a sheriff s office convenient (vs. 84% at a pharmacy) -SoundStats Survey of King County, 2006

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15 Washington State Population Density

16 Without Legal Disposal Pathways Hospice: Narcotic disposal to driveways Undocumented collection and transfer of material Free incineration at pulp and paper mills (saw mills) Community event collections variety of settings Unique forms of treatment (concrete, paint, kitty litter, coffee grounds, & sharps containers) Mobile low temperature incinerator units

17 PH:ARM Pilot Includes all pharmaceutical products* 35+ Retail pharmacy locations (Bartell Drug) 25 Clinical pharmacy locations (Group Health) 20 nursing homes (Rainier Pharmacy Service Area) 2 years in length

18 Materials Accepted into Program

19 Collection, cont. No business waste because of hazardous waste laws No aerosols because of DOT shipping requirements (inhalers ok) No biomedical waste because of safety and transportation permitting in Washington No personal care products because of volume

20 1 st Phase: Group Health Cooperative Washington State HMO (1 location in Idaho) 500,000 Customers 1 central warehouse 7 pilot locations in 5 counties (King, Snohomish, Thurston, Kitsap, and Spokane) 25 total pharmacies, launching in April

21 Instructions to Public Gather your unwanted medications (see list to find out which items can be returned). Leave items in the original containers. Mark out any personal information if you wish. Bring medications to a participating pharmacy. Deposit medications into the secure bin marked for medication return.

22 Group Health Decal

23 Group Health Flier

24 Pharmaceutical Drop Box- dvault prototype

25 Group Health Clinic

26 Double Locked Container

27 Bucket Closed with Lock Lid Under Double Witness 27

28 Each Bucket Has Unique Tracking Number and Security Tag

29 Each Bucket Is Tracked 29

30 Buckets are Returned to Pharmacy Distribution Center, Recorded, and Placed in Locked Cage

31 When Enough Buckets Have Accumulated, They Will Be Picked-up For Secure, Witnessed Destruction

32 Results (thus far) of PH:ARM Seven pharmacies generating a five gallon bucket a day, or 8-9 lbs average (gross weight) 100+ buckets since October lbs of medication (net weight) Estimate: 1,000 lbs a month from 25 GHC clinics

33 Next Phase: Retail Pharmacy Bartell Drug Company 1 central warehouse 54 total locations

34 Bartell Drug Company Sample Poster

35 Sample Bartell Flier

36 Bartell Drug Company Prototype

37 Barrier: Controlled Substances Controlled substances are about 10% of waste in other collection programs Abuse/ diversion is key issue for DEA Controlled Substance Act creates closed system of inventory Can only be transferred to exempt agencies DEA seeks to destroy controlled substances beyond reclamation Rules don t acknowledge the presence of waste or need for disposal

38 Solution: DEA Waiver Request Wa. Board of Pharmacy submitted request to DEA in March 2007 Detailed protocols for collection at Group Health Cooperative and Bartell Detailed protocols for disposal at a generic Hazardous waste incinerator, and at a MSW incinerator (back-up plan) Numerous support letters

39 Barrier: Final Disposal Recycling/ reuse extremely difficult at this time Lack of Vendors with the right permits, or permission to assist with waste problem DEA material prevent vendor participation Environmental Unknowns e.g. constrained by commercially available options and lack of data Cost of disposal not easy to absorb by retail or local government budgets. Estimated $150,000 for 100 pilot locations/ yr

40 Solution: Waste Sampling Need sampling for: Safety Environmental information Cost information Pollution prevention efforts Waste Profile Challenges are: Labor Logistics Security

41 Waste Sampling 1 st Sampling Event (Qualitative only): lbs (net weight) 1.1% rate of non-pharmaceutical items, such as glucose meters, disinfectants, & personal care products 2 nd Sampling Event (Qualitative only): lbs (net weight) Greater contamination rate (1 sack of garbage, a bin of personal care products, disinfectant, & 2 aerosol cans) More comprehensive sampling coming soon

42 Sampling Results- Group Health

43 Some Items Found Glucose meter Copaxone, unused, worth $1,500? (immunomodulator therapy for the treatment of Relapsing- Remitting Multiple Sclerosis)

44 Occurrence of Garbage and Personal Care Items

45 Barrier: Financing Short term: grants from foundations and governments ($250,000+) to non-profits and local governments through 2007 Governments and pharmacies (in-kind) Long term: producer responsibility

46 Resources for Household Disposal and PH:ARM White Paper and overview at Consumer Survey at

47 Thank you! Emma Johnson Washington State Department of Ecology Solid Waste and Financial Assistance Program